Our eleventh Undark podcast looks at the health risks posed by lead ammunition, the anti-vaccine movement, and the life of a standardized patient.

Join our podcast host and former NYT Science Times editor David Corcoran as he discusses Undark’s latest Case Study on the health and environmental risks posed by the use of lead ammunition with writer Lynne Peeples. Also: Seth Mnookin talks about the anti-vaccine movement, and storyteller Hillary Rea explains what it’s like to be a standardized patient for medical students.

A full transcript of the podcast follows.

David Corcoran: This is Undark. We’re a magazine devoted to exploring the intersection of science and society, and we’re this podcast. Hello, again. Welcome to episode 11 I’m David Corcoran.

For our cover story, more troubling news about lead. Everybody knows that lead is highly toxic, but if you’re like me, you probably thought the main threat was in lead paint and old water pipes like those in Flint, Michigan. It turns out there’s an even more obvious source of lead poisoning that most people never even think about. Joining us to talk about it is the author of our cover story, environmental reporter, Lynne Peeples. Hello, Lynne.

Lynne Peeples: Hi, David. Thanks so much for having me.

David Corcoran: Your article opens at a very noisy shooting range in a little town of Enterprise, Oregon. You’re all dressed up in safety goggles and ear muffs. What are you doing there?

Lynne Peeples: Right. I drove to the tiny town in Eastern Oregon to see firsthand the source of some of these concerns surrounding the ongoing use of lead ammunition and also to see what some of the alternatives which are coming out look like. A biologist from the Oregon Zoo had just come to town from Portland to give a demonstration on the differences between lead and copper bullets, how they shoot, how well they might penetrate a game animal, how they might fragment differently within an animal. That there is where a lot of the concern lies which I know we’ll get into later.

David Corcoran: Describe what happens when a lead bullet hits its target?

Lynne Peeples: Lead is naturally soft and historically that’s been a very convenient thing for ammunition to help the Greeks and Romans for example easily form little lead balls to shoot from slingshots. Then when we began stretching the lead to form streamline projectiles for rifles, it also produced another benefit. That characteristic softness meant it actually squished and widened upon impact.

That meant that there was more damage to the animal. As a hunter hopes, it means the animal dies faster. The last thing a hunter wants is to injure an animal and leave it to suffer or have to chase it down through the forest to fire a second bullet.

There’s also some drawbacks to that softness. It means the bullet can literally break down when it strikes and goes into an animal. It can leave these little particles of lead. Some not even visible to the naked eye. This is what concerns health advocates and researchers who counted in some cases hundreds of fragments of lead in x-rays of downed animals.

In fact, there’s been up to more than 700 fragments counted in some of those x-rays. Now, this has ramifications for the hunter and his family if he’s taking the meat home to eat. Of course it has implications for other wildlife too. The hunter typically trims and discards the guts of the animals they take. That means much of the lead may stay out in the field in these so called gut piles which is actually a key source of food for many eagles and other raptors and wildlife.

Meanwhile, studies also show that the lead can actually extend as far as a foot-and-a-half from the bullet’s path through an animal. Those fragments can scatter throughout the animal. That typically extends beyond where a hunter will cut out those innards. A three-foot wide shank is not typical for what a hunter would cut out. Worries extend to what might be taken home in the meat as contamination essentially for the family.

David Corcoran: You mentioned that the biologist that you visited with at the shooting range was comparing the effects of lead bullets with copper bullets. How are copper bullets different from lead in this respect?

Lynne Peeples: Copper itself is a harder material than lead. That means that it is inherently less likely to break apart on impact and more likely to penetrate further into an animal. As Leland Brown, he’s the Oregon Zoo biologist that came to the range, showed us with a demonstration by shooting the copper bullet into this barrel that he had set up with five-gallon jugs of water lined up in each barrel, the copper bullet actually was able to penetrate all five-gallon jugs of water with one shot as compared to the lead bullet which actually only penetrated two of those five-gallon jugs.

The penetration was further and also within that rain barrel that he shot the bullets into the copper bullet did not leave the same kind of fragmentation. The barrel in which we shot the lead had a scattering of lead particles in the end. Actually, we had a chance to look at the weight difference of these spent bullets after the demonstration and the copper bullet retained nearly all its weight. It was about 99% I believe of its initial weight whereas the lead bullet was down to about 75% of its initial weight.

The copper bullet you asked used how it differs, unlike lead, again lead naturally squishes into sort of mushroom shape on impact. Copper, because it is so hard doesn’t naturally do that. Engineers over the last couple of decades have been working at designing a bullet that will mimic that mushroom pattern. With copper, they have now developed a way in which that bullet will … When it strikes the animal splay into petals and that naturally exempts the diameter of the bullet just as the lead bullet naturally gets wider upon impact.

It will then do the same kind of damage that you want the bullet to do. A wider bullet going through an animal is going to cause more damage and it’s going to down the animal faster. This engineering, the science technology has improved quite a bit in recent years. I spoke with one manufacturer. They began making copper bullets in the early 1980’s. Now, they have gotten the bullet to at least double its diameter upon impact.

David Corcoran: I take it that copper is also much less toxic than lead.

Lynne Peeples: Right. That is significant part of the equation. There is some studies out there that suggest copper isn’t necessarily 100% safe. There is some controversy over that, but the key point here is that the copper does not leave itself behind in the animal in the same way that the lead does. It maintains its form and doesn’t leave those particles of toxins throughout the animal.

David Corcoran: Why is lead so toxic?

Lynne Peeples: We’ve long known lead as toxic. I mean, the Greeks going back to the days when they were first making those little lead balls and slinging them at their enemies, they recognize the toxicity. Then it was more this acute significant poisoning that people were aware of. The results would be anemia, [inaudible 00:07:20] death. We’ve learned in more recent years just how damaging even small exposures to lead can be and perhaps most well known are the risk to the developing child or a fetus.

Significant exposure in the womb to lead can result in serious brain damage for a child. We know that these neurotoxic effects can also be really subtle rather than a child having an obvious brain damage, they might simply have a few points lower in IQ or maybe a little more trouble learning, or paying attention, or behaving properly as a child and going on into the adult years.

In fact the CDC in 2012, lowered what they considered child to be a lead poison from 10 to 5 micrograms per deciliter. Even just this week, they’ve come out with another report stating that it’s something they’ve long said, but that there is no safe blood lead level in children. In fact there’s reports that they’re now considering lowering that threshold even further to 3.5 micrograms per deciliter.

Just how lead does its damage is something researchers are still trying to tease out, but we do know at this point that lead can do some of its damage by mimicking calcium in the body. Just like calcium is stored in bones by mimicking calcium, it ends up stored in bones and can then leech out. Sometimes at really inopportune times such as when a woman is pregnant, calcium, we know naturally comes out of her bones to help nourish that growing fetus. Lead will do the same thing. It will take the same trip and get into the womb and the growing fetus.

The concerns go beyond children too to adults. There’s more and more research coming out in recent years that adults exposed to similarly low levels below five micrograms per deciliter can have some pretty drastic consequences to their brain, heart, immune system, reproductive systems, potentially linked to things like cognitive decline and kidney disease.

David Corcoran: You mentioned that it’s just not hunters who are suffering these effects. Talk about some of the people for whom lead is an occupational hazard.

Lynne Peeples: The issue does go well beyond hunting. We’ve got more than 20 million Americans who shoot recreationally, but there are also hundreds of thousands of members of the military and law enforcement who turn out to spend a lot of time and indoor and outdoor firing ranges for their training. Then there’s also those that are working at those ranges.

We have a large segment of the population potentially exposed and the biggest concerns tend to be around indoor shooting ranges, especially those that are not proper ventilated. Depending on the type of gun used, lead might be released when the gun is fired on one of those ranges. The explosive agent that ignites the gun powder can contain lead and even some vapors can be released from the lead bullets itself due to the heat when the gun is fired.

These indoor shooting ranges, if they’re not properly cleaned or ventilated, the air can contain lead dust and fragments and the space can contain lead. That can pose a risk for anyone through inhaling that lead, ingesting that lead. Say they touch a surface that has a lead on it and go eat something afterwards without washing their hands. It can also be absorbed through the skin.

During my reporting I spoke with a former police officer who got really acutely sick with lead poisoning during training. She recalled the haze that filled the air of the firing range turned out that the range’s ventilation system had gone out, but she and her squad hadn’t been taught anything about lead poisoning or the dangers and so they just kept training right on through it.

David Corcoran: Some of the numbers in your story about the amount of lead found in birds of prey was truly astounding. Can you tell us about the effects on eagles and other predatory birds?

Lynne Peeples: Like humans, there’s definite concern about significant acute exposures. Like with humans, if a bird and just a significant amount of lead, they might get acutely ill, they might die relatively fast. We definitely have that concern that something that researchers have seen in the field. At the same time like humans, birds can be exposed to small amounts even chronically exposed to small amounts of lead if they continued to eat from these gut piles.

That can pose some perhaps hidden consequences as researchers in Jackson Hole, Wyoming explained to me. They’ve measured blood lead levels in raptors and they found moderately clinically significant levels that may not really present themselves as obvious in the bird, but they feel might lead some to be more prone to, say, starvation if they’re lacking some of the medical capacity and physical capacity to hunt or they might be more prone to run into a wind turbine or an electric pole.

This could be resulting in again a loss to some of those population levels which are so hard to measure. They also have told stories of birds that were obviously poisoned and just how heartbreaking it is to see these birds with their drooping wings. Sadly some covered in their own diarrhea, confused, but there’s the whole level just with humans as with birds, the level of exposure and the potential consequences.

There’s also the concern that some of these effects could be even more subtle across the population. For example, it’s typically the fittest birds who would be the strongest predators who will be the first to feed on a gut pile. You think the strongest birds, if you’ve follow Survival of the Fittest, they’re going to be the ones that in a healthy environment will continue to breed, but since these strongest breeders end up to be the first at the gut pile, they’re also the first to be affected by this lead poisoning. As a researcher explains, this could lead to a reversal in the natural survival of the fittest.

Around some gun ranges that don’t take the proper precautions particularly outdoor gun ranges, there’s also been issues with contamination in nearby soil and water. As we know lead doesn’t go away. It stays put unless it’s cleaned up properly. There’s been some reports of residential developments other construction going on, on sites of former gun ranges in which they even uncovered lead contamination. That’s yet another issue altogether.

David Corcoran: This sounds like a no-brainer. I mean lead is clearly toxic. It’s having these effects on hunters, law enforcement officers, military people and of course as you said predatory birds like eagles and condors. Given all this, I was surprised to read that lead bullets still have their defenders. Why and who?

Lynne Peeples: Good question. We do know that the gun industry has lobbied against bans on lead ammunition. In California, the National Shooting Sports Foundation, an arm of the NRA increased their financial resources in the states sevenfold in 2013 which is when a debate over a state ban on lead ammunition had begun heating up.

We know the NRA has backed a provision that prohibits the EPA from banning lead ammunition. When you really dig down to it, they make a few points. One is that they suggest there’s true concern about what they call a slippery slope that these bans on lead ammunition could lead to a threat to the second amendment. This is something that hunters and other recreational shooters did express that they don’t want to lose their guns. They did not want to lose their right to hunt.

On an NRA backed website, they actually target and aimed to debunk some arguments against the continued use of lead suggesting the science isn’t clear that lead ammunition poses any real threat to the health of humans or to wildlife. They emphasized the lack of proof that there’s been population-wide impacts on species such as bald eagles.

As some scientist explained to me, getting proof of population-wide impact is actually near impossible. Some experts suggest that the firearms industry is actually following a similar playbook as tobacco, flame retardant and fossil fuel industries. The firearms industry also warns that banning lead ammunition will dissuade people from hunting which hunting through licenses and tag fees is actually a significant source of funding for conservation.

As the Hunt for Truth Association website, that website I mentioned that is supported by the NRA, as it states on the site, it’s members will “remain vigilant” in their desire to maintain the use of lead ammunition while continuing to preserve America’s “traditional” hunting heritage. Of course, many folks are left confused. Who and what should they be believing.

David Corcoran: Lynne, what is the outlook here? You say in your article, some states have enacted or at least considering laws that would ban lead ammunition in certain circumstances anyway. Where is this all going do you think?

Lynne Peeples: Advocates are pretty optimistic. As they see more and more copper bullets making it to the market and watching the prices of those bullets dropping within pretty comparable range to many lead bullets. In fact there was a new copper ammunition that came out this summer that does fall at about $28 a box which is well within the range of lead ammunition. With that kind of markets change as well as some legislation as you mentioned starting to get passed like in California legislation was passed that eases into a ban in lead ammunition so by July 2019 only non-lead ammunition can be used for all hunting in the state.

That’s pretty significant. There are other laws that states have passed in recent years that do push federal legislation that passed in the early 1990s banning lead shot from water fowl hunting. That was the first but these state laws have taken things a step further but none have even closed anything that California is doing. Usually those laws are incremental, might have to do with parts of the state, certain kinds of bullets, usually having to deal with a shot which is a little different than most of what we’re talking about here with rifle ammunition and hunting.

This California law some advocate suggest means the writing is more or less on the wall for lead ammunition. Minnesota, another state that’s looking to prohibit the use of lead ammunition for bird hunting on state lands yet there’s still a lot of confusion out there. There’s still a lot of, as folks suggest, foot-dragging on really making this transition efficient and possible which is why folks like Leland Brown of the Oregon Zoo and others tell me that they’re trying to educate and raise awareness as best they can to help speed up this process and help folks realize what the options are and make an educated choice when they choose their ammunition and go out whether it’s to a shooting range or out to hunt.

Along those same lines, there’s actually a new study that has begun out of the University of Massachusetts Amherst which researchers are trying to shed some light on hunters attitudes and beliefs on lead ammunition, trying to get out where they get their information, how they’re forming their opinions and how that’s affecting their choices. Overall there does seem to be hope. Advocates do see some evidence that things are moving in a better direction but they feel like it is a little too slow and years too late but they’re hopeful.

David Corcoran: Lynne Peeples writes about science, health and the environment from Seattle. Her work has appeared in the Huffington Post, Scientific American, Reuters, Popular Science and Undark where she is the author of this month’s case study on the health and environmental consequences on lead bullets. Lynne, many thanks for joining us.

Lynne Peeples: Many thanks to you, David. Thanks for having me.

David Corcoran: We’re joined as always by Seth Mnookin who follows science and the media for us. Hey, Seth.

Seth Mnookin: Hey, David. How are you?

David Corcoran: I’m good thank you. A lot to catch up with this month. Let’s start off at Trump Tower, shall we?

Seth Mnookin: My favorite place to be always.

David Corcoran: Shortly before his inauguration, President Trump held a meeting there on a subject very close to your heart.

Seth Mnookin: Right before the inauguration, I guess what people can agree on is that he had a meeting with Robert F. Kennedy, Jr. There was immediately some disagreement about what that meeting was about. RFK Jr. said that he had been asked to chair a commission on vaccine safety and perhaps also autism. The Trump team later on that day, I believe said that, “No. That was not actually the case.”

David Corcoran: We should say here that Robert F. Kennedy, Jr., son of course of the late Attorney General Robert F. Kennedy and a noted environmental lawyer in his own right who’s adopted this side interest in the alleged connection between childhood vaccines and autism.

Seth Mnookin: Yeah. I would say is one of the more irresponsible people about vaccines. He really first became known for being involved in this over a decade ago when he published a piece jointly in rolling stone and so on that alleged a massive decades long worldwide conspiracy to cover up the dangers of vaccines and that article that he wrote had so many errors, so many glaring errors and not just errors but really aggressive misrepresentations of what people had said in multiple places.

He was taking quotes from a transcript and he would take one sentence from one paragraph and then another sentence from dozens of pages later and act like they had been said at the same time and completely changing the meaning. He changed numbers. It was as irresponsible a piece of journalism as I’ve seen in a long time.

David Corcoran: This was a key part of your book, The Panic Virus, am I right?

Seth Mnookin: It’s something I definitely wrote about and acknowledge in address as one of the reasons why this completely baseless devoid of evidence claim that there’s some causal connection between vaccines and autism. One of the reasons why it gained traction certainly was because of RFK’s and premature. Then he went on even after the piece had been corrected and keep repeating his misrepresentations and the untruths when he was interviewed on other media, on TV.

Since then despite the fact that the piece is now been officially retracted by Salon on despite all of the other evidence that has come down, he has continued to for whatever reason hold on to this notion that there is this massive decades long conspiracy involving pharmaceutical companies and governments around the world.

David Corcoran: He meets with the soon to be president. How does this become a media story?

Seth Mnookin: He came down from Trump Tower and immediately told the press there that he had been asked to head up the safety commission and I remarked at the time, it would be a little bit like asking David Duke to head up a commission on race relations. Just the notion that you would take someone who has been so dishonest about this, intellectually dishonest, so misrepresentative of reality and say, “Here, why don’t you go look at the very issue that you are misrepresenting,” is astounding.

Trump has, I’m not sure if you would call it flirted with, but dabbled with vaccine conspiracy theories for a while on and off for several years. I guess this wasn’t holy surprising. What is interesting to me is that while this might have been a position that made some tiny amount of political sense a decade ago, over the past decade not only has there been so much more evidence disproving all of these claims, but also we’ve started to see some of the dangers of when parents choose not to vaccinate in terms of measles outbreaks, hospitalizations.

Now, unlike in 2005, 2006, there really are parents and certainly pediatricians and public health officials but larger and larger number of parents who view this as really irresponsible and something that has the potential to negatively impact their own children’s health even if they are trying to do everything they can to protect them.

David Corcoran: One of our more respected science publications, science magazine did an interview with Robert F. Kennedy, Jr. after this meeting with the president elect. How did they handle that?

Seth Mnookin: This was the same day. I think it was late morning that RFK came and made this announcement. Before 5 pm, that afternoon, Science had posted a straight Q&A with RFK Jr. The reporter for science magazine did make clear and heard questions that she viewed these as settled issues and that there was no evidence. It was a decision that I thought was pretty unfortunate because what it did even while the reporter was saying there’s all this evidence showing that isn’t true, it presented it as on the one hand, on the other hand.

It made it seem as if RFK had equal legitimacy behind him as this reporter who actually is an expert on vaccines and knows an enormous amount about them and also understands science and s responsible of reporting it. I do not think that that is an appropriate way to report on something like this. The reason I don’t think that is not because I think that the public is stupid but there’s actually an enormous amount of research that shows that if you state something even if you were stating it within the context of saying that it is false, a very significant number of people are going to come away from that thinking that it’s true.

One of the most striking examples for me about this was not long after my book came out when one of the foundational papers claiming that there was this link between vaccines and autism was published, there were surveys done and there were people who had never heard of the alleged link before the paper was withdrawn because it was fraudulent who then after hearing that thought that there was a link which is astounding.

By giving RFK Jr. free rein to say what every he wanted to say in the context of a Q&A, I think it’s naïve to think that that is not going to lead some people to come away from that thinking that his views are accurate.

David Corcoran: The Q&A interview has become quite a popular form. We do it ourselves at Undark. We have a feature called five questions where we interview an expert about something and let him or her hold the forth. It sounds like this is kind of fraught with peril. What’s a good way for a news media outlet to handle this kind of interview?

Seth Mnookin: I think Q&A can be incredibly informative because it gives the person who’s being interviewed a chance to speak with less of a filter than they would normally and there’s a lot of places that do it really well. I don’t think that we as science journalists should be doing those stories with people who have views that are not supported by science.

If you want to do a Q&A with a scientist about her breakthrough research or what it’s like to be a scientist, the culture of science or how their career started out or any of that, that’s great. I don’t think it’s appropriate to do a Q&A with someone who has views that are not widely supported by the evidence because just by doing the Q&A, you’re making an editorial decision saying this is a legitimate viewpoint that deserves to be heard.

Even if it’s within the context of a lot of people disagree with you it still is granting more legitimacy to those views than should be granted. There’s no shortage of importance science stories out there that are not getting the attention they deserve. It’s hard for me ever to understand the rationale behind running a Q&A with someone who is on the fringe of science and of evidence.

David Corcoran: Does this story fit in to a larger pattern where you have a set of assertions a controversy, the controversy gets largely resolved, the assertions get debunked and then suddenly they spring up again as if the previous discussion had never happened? It seems like this is something we’ve seen a lot of lately.

Seth Mnookin: I think that one of the things that’s going to be interesting is how we as the media deal with this. In my book, one of the things I talked about is that while there were a lot of people who you could point the finger at in terms of starting this kind of manufactured controversy, the people or the group that I really concluded with most to blame was our colleagues in the media because while this was consistently settled science, it was presented as on the one hand, on the other hand issue. I think that’s an irresponsible way to treat questions of science that are settled.

Over the years we’ve seen that with climate science. Science has become so politicized that we’ve seen that again, and again, and again. We’ve seen it around fracking. We’ve seen it around genetically modified organisms. I think a challenge for the media is going to be taking these issues about which there really is not debate and then figuring out a way to cover those issues when the president of the United States is advancing ideas that are essentially fantasy.

How do you deal with that and how do you deal with that in a way that is responsible and at the same time not ignoring what the leader of our country is saying? I think my view is that it’s paramount to frame that in a way that makes clear when someone is not being honest and when someone is misrepresenting reality.

We need to do that even if that happens to be the president of the United States. You don’t get a free pass to lie at will or misrepresent at will because you are the president.

David Corcoran: Seth Mnookin comments for us about media and science. He’s the author of a number of books including The Panic Virus and he’s director of the graduate program and science writing at MIT.

Every medical student in the United States is required to take a clinical skills board exam in order to graduate from medical school and move in to residency. This exam is a full day event where each student spends time with 12 patients but they aren’t real patients, they’re actors. They portray a colorful assortment of people who come to the doctor with a variety of elements. Hillary Rea has been a medical actor for nearly for nearly seven years. She tells our next story.

Hillary Rea: You know the Seinfeld where Kramer and his friend get jobs as actors for medical students, they are assigned diseases to portray and Kramer competes to play the character with gonorrhea. With an audience of medical professionals, he delivers a monologue about his symptoms while smoking a cigarette and wearing a red blazer.

Doctor: Are you experiencing any discomfort?

Kramer: Just a little burning during urination.

Doctor: Any other pain?

Kramer: The haunting memories of lost love.

Hillary Rea: This is a real job. It’s called a standardized patient. It’s not too far off from how it was portrayed on TV. I’ve been an SP for seven years and I have seven years worth of stories. This is me recounting one of them in a live story telling event for The Moth.

I’m a standardized patient so I’m an actor that acts out different diseases and medical things for medical students and I usually get things like lupus or pelvic inflammatory disease or [crosstalk 00:34:00]. It gets weirder. I’ve simulated birth three times.

I’m brought in to this fake hospital room. It’s a simulation room. I’m wearing bike shorts and a tank top and they strap on this prosthetic full-term torso on to me complete with a rubber vagina that opens up and there’s placenta inside and I’m also holding the baby’s leg upside down because I’m in control of this baby coming out of me.

I used to be scared of going to the doctor’s office. I had white coat syndrome before I knew what it was. I fainted in the elevator after getting a hepatitis B shot for my pediatrician. Even a visit to the dermatologist gave me heart palpitations. At first, being a standardized patient was just a job that paid my bills while I pursued my career as an actor and storyteller, but I grew to love it as a communication tool.

It made me excited for my real doctor’s visits and I developed the highest of standards for my medical care. I have this idealized version of what the doctor patient relationship should be. It’s just not about the diagnosis or telling me that I have a clean bill of health. I want to connect with my doctor on a human level. I want empathy and rapport and collaboration.

Standardized patients were first used in 1963 by Dr. Howard Barrows at the University of Southern California. Over the past 10 to 15 years, they become an integral part of all medical school training, but even so they’re not something that all med students are actually aware of.

Chris DeFrancesco: When I thought about, “Oh, I’m going to go to medical school, it wasn’t like standardized patients were something that I pictured being such a big part of medical school.

Hillary Rea: Chris DeFrancesco is a fourth year medical student at the University of Pennsylvania where they introduced standardized patients into the medical school curriculum at year one. Chris still remembers his very first encounter.

Chris DeFrancesco: With my learning team and we’re up in the biomedical research building, it’s our job to talk the standardized patient and we know zero about medicine. Just having a full patient encounter, you’re nervous to do that. You’re wearing the white coat. You’re in a new overall and you are realizing that this is the expectation for me. This is where I’m moving.

Hillary Rea: Even some resident physicians are required to see standardized patients. Riley Lipschitz is in her third year of residency in internal medicine and primary care at U-Penn. She sees real patients everyday and participates in patient’s simulations throughout the year. The SP encounters make her realize that even as a resident, she still makes mistakes.

Riley Lipschitz: I started the encounter, I was confused. I thought this was somebody that I had met before in my fake experience. I thought that this was a patient that I’d known and so I walked in. I was like, “Good to see you. Glad you’re back,” because I have no idea who you are.

Hillary Rea: She says it’s good to have these reminders.

Riley Lipschitz: At my primary care clinic, if I don’t communicate well with my patient, I rub them the wrong way or they’re not happy with me. They don’t tell me often, they just don’t come back.

Hillary Rea: I’ve gotten to the point where I feel like an advocate for those type of training. I have all of these ideas of how it can help and change not just medical education but the entire healthcare system. It’s comforting to know that there are medical professionals who feel as strongly as I do.

Riley Lipschitz: I think the standardized patient experience definitely can influence medicine and continue to be more robust, but there’s another step that I think we could still do better at which is about practicing different ways of speaking.

Hillary Rea: I recently switched primary care doctors. I had a series of symptoms that were misdiagnosed. This lead to an emergency gallbladder surgery while I was at the beach on my summer vacation. A few months earlier I had suspected that my symptoms were related to my gallbladder. I had just finished playing a gallbladder patient and it was identical to what I was experiencing. My doctor knew how enthusiastic I was about my job and maybe because of this she discounted my self-diagnosis.

When I returned to her after my surgery, she could only respond by saying, “I’m sorry for whatever part I played in ruining your vacation.” I didn’t leave her practice because of the misdiagnosis. The damage have been done. I left because of the way she responded to it.

Riley Lipschitz: It’s absolutely paramount for any good doctor to be a good communicator whether you’re a surgeon or a primary care doc or a pathologist. No matter what, you should be able to do that. I think it’s a skill that not just innate, but learned and you can practice.

Hillary Rea: There are physicians who communicate like my primary care doctor and then there are ones like Riley and Chris. Sometimes it feels like I’m just pretending to be a bartender with a bad sinus infection. If I had to play the voice of a mannequin who’s had a bad fall, it’s hard to feel a human connection, but I know I’m helping the medical education system in some way and I’m hopeful that it can make the improvements it needs to make. It just takes practice. For Undark, this is Hillary Rae.

David Corcoran: That’s all for this episode of Undark, a project of the Knight Science Journalism program at MIT. Our show is produced by Katie Hiler. We’ll be back next month with more news and interviews from the intersection of science and society. Until then I’m David Corcoran for Undark.